Approaching Death.ppt

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1、Approaching Death,Death and Dying,Death and Dying,“Immortality” of youth Denial of mortality Anxiety,Historical and Cultural Views,ability to accept death specific meanings (stop breathing, heartbeat, brain death) individual variation cultural variation (spiritual, natural, welcome event),Western hi

2、story: natural event 20th Century: withdrawn from daily life experiences care of dying Disposition of deceased: dramaturgical (Fulton & Metress, 1995: language of funeral directors) “interment” vs. burial “casket” vs. coffin “remains,” “diseased,” “loved one” vs. corpse, dead body “lying in repose”

3、vs. dead “denial” of death, “social”death: avoidance,Cultural denial of death? Behaviours? Avoidance? Collectively? Individually? Reasons? Effects of avoidance? Feelings about death? Regrets? A “good” death?,Research on Death and Dying,Kubler-Ross (1970) Openness, disclosure thanatology: study of de

4、ath five emotional stages Denial, anger, bargaining, depression, acceptance,Inconsistencies in Stages,appearance, reappearance of denial, anger, depression during dying process age of dying person young: separation from loved ones adolescents: focus on quality of present life effect of condition on

5、appearance social relationships,young adult: rage and depression end of life at beginning middle adulthood: concern about obligations, responsibilities late adulthood: contextual death of spouse illness, pain, dependency acceptance relatively easy,Health Care Policy for the Dying Process “Medicaliza

6、tion” of death vs. “normative” part of life? Perspectives, definitions of death? Death anxiety? Preparation for death?,Hospice Care vs. “Medicalization” of Death,“good death”: swift, comfortable, dignity, loved ones present more common prior to extreme medical intervention alternative to hospital ca

7、re,London, 1950s: first hospice Provide medical care, no artificial life support systems to terminally ill Allow visitors, free movement Cushion fear, loneliness of impending death,Problems: Rapid growth: need for well-trained personnel Legal, ethical questions: premature death? Potential burn-out o

8、f professionals, volunteers (personal involvement, intimacy),Living Will, Passive Euthanasia,specify how much medical care in terminal illness inaction (e.g., no respirator) that allows person to die in natural course of illness ethics: quality of life?,The Right to Die: Assisted Suicide and Active

9、Euthanasia,providing means to person to end life intentionally terminating life of suffering person Netherlands: legal euthanasia North America: Jack Kevorkian assisted suicide? Value of life? legal restrictions?,Netherlands,Patient experiencing unbearable pain Patient conscious Death request volunt

10、ary Patient must have time to consider alternatives No other reasonable solutions to problem Death cannot inflict unnecessary suffering on others Must be more than one person involved in euthanasia decision Only doctor can euthanize the patient,Death Anxiety,(Conte, Weiner, & Plutchik, 1982) Death A

11、nxiety Questionnaire fear of unknown fear of suffering fear of loneliness fear of personal extinction,nursing home residents, seniors, university students ages 30 to 80 years no differences in mean scores (M=8.5) no correlation with sex, education separate study: adolescents had higher scores than o

12、lder participants emotional stresses cognitive maturity (meaning of death),Cicirelli (1999) higher death anxiety in: Younger Lower SES Female White External locus of control Less religiousness,Quality of End of Life,Singer et al. (1999): Canadian sample Receiving adequate pain and symptom management

13、 Avoiding inappropriate prolongation of dying Achieving sense of control Relieving burden Strengthening relationships with loved ones,Bereavement and Grief,Mourning: expression of grief Prescribed rituals: funerals Auger (2000): 4 functions Provide supportive relationship for bereaved Reinforce real

14、ity of death Acknowledge open expression of feeling of loss and grief Mark a fitting conclusion to life of person Social support network of familial small memorial services failure to express grief: depression,Phases of Mourning (Parkes, 1972) shock longing depression, despair (anger) recovery (pers

15、pective),Current Perspective (Lund, 1996),stress with resiliency adjustment related to self-esteem, coping skills diversity between individuals: thoughts, feelings, behaviours within individuals: simultaneous negative (anger, loneliness) and positive (personal strength) feelings,no stages: rapidly c

16、hanging feelings dealing with personal limits fatigue, loneliness learning new skills new relationships no specific time markers,Achieving Recovery,cultural facilitation of mourning: meaningful rituals emotional support: friends listening practical help lengthy process waves of sorrow: anniversary r

17、eactions healthy response,Bereavement overload,elderly at risk several deaths in rapid succession unable to complete mourning process for one death before another occurs,Anticipatory Grief expected death dying person, mourners share affection helps dull pain of loss Sudden death (no anticipatory gri

18、eving) Most difficulty in coping loss of young person vs. at end of long, full life emotions: guilt, denial, anger, sorrow,Social/Cultural Supports for Grieving?,Similarities, differences, roles?,Finding Comfort,social support: friends listening, sympathizing, not ignoring pain, complex emotions in

19、recovery recognize bereavement is lengthy process (months, years): sorrow, memory are integral parts of recovery over time: bereaved should become involved in other activities, but not be expected to forget loved one successful recovery: deeper appreciation of growth, development of all human relati

20、onships,Adult Development from Adolescence to Old Age,Multidimensional, multidirectional change, throughout lifespan,Final Exam December 12: 2 hours Chapters 8, 10, 11, 12 (50 Multiple Choice), lecture material (5/7 short answer),Successful Aging,Survival in late adulthood Quality of life, satisfact

21、ion Transcend physical limitations Mental health, optimal adaptation Positive outlook Self-understanding Components Absence of disease, disability No risk factors,Maintaining high cognitive and physical function Active and competent Engagement with life Productive activity, involvement with other pe

22、ople,Not avoidance of aging: maintaining adaptability Consistent with reality of aging: Successful aging is the norm “paradox of well-being” (Mroczek & Kolarz, 1998) 32,000 US adults surveyed Assumed objective difficulties Generally fel good about selves and situation 30-40% over 65 report selves as

23、 “very happy”,Positive affect: highest for olderreflects personality (extroverts)set point perspective- temperament sets boundaries for levels of well-being throughout life - extroverts: more successful dealings with others- positive interpretations of life events,Successful Aging,Hardiness and thri

24、ving (Perls, 1995) Genetic determiners of “hardiness” in oldest old Adaptive capacity (ability to overcome disease or injury) Functional reserve: how much of organ required for adequate performance (determines ability to deal with disease),Survivability,Beyond age 97, chances of dying at a given age

25、 lower than expected Mortality rate (#deaths/# in age group) exceeds 1.0 if entire group dies in less than one year Indicates oldest members of our species tend to be healthier than traditional views of aging would predict Additional support from medflies Chance of dying at any age peaks at 50 days

26、(15%) If survive to 100 days, chance of dying at any given day 5%,More hardy Slower rate of progress of symptoms of disease than in less hardy Threshold for disease lowers more slowly,Symptoms of age-related disease (e.g., Alzheimers) appear later (b vs. a) Morbidity, mortality, disability compresse

27、d into shorter period,Possible explanations for hardiness,Longevity genes: increased resistance against oxygen radicals Slow rate of damage Low complement of deleterious genes E.g., Apolipoprotien E (apo-E) related to risk of Alzheimers Gene for protein apo-E less prevalent in oldest-old survivors 1

28、8% of 90-103 year-olds 25% of under-65 year-olds,Adaptive capacity (ability to cope with and overcome disease or injury) higher in more-hardy Functional reserve (how much of an organ is required for its adequate performance) higher,Autopsy studies of “healthy” oldest-old brains No outward signs of d

29、isease, but level of neurofibrillary tangles would indicate dementia in younger brain Excess reserve of brain function compensates for processes damaging the brain,Two Basic Principles of Normal Aging,Variability of aging rates Longitudinal studies (e.g., Baltimore Study) Aging rates vary remarkably

30、 (60 year olds like 40; some 40 year-olds like 60, physically) Differences in appearance mirrored on physiological tests Variability increases as age increases Individual aging rates vary across years, and across physical systems,Variability of Aging Patterns Several aging paths:Cross-sectional rese

31、arch Some functions decline in a regular way over time Other functions are stable, unchanged or decline only in terminal phase of life,Physiological loss, but only when an age-related illness is experienced E.g., heart disease correlated with a decline in heart pumping capacity with age Without hear

32、t disease, pumping capacity as well at age 70 as at age 30,Terminal Loss Pattern Loss in a normally stable function may be sign of impending death E.g., immune system: # of lymphocytes (white blood cells) stable normally stale Decline occurred in minority of Baltimore Study sample Reported good heal

33、th; good physical exams At next follow-up for study subgroup more likely to have died,Loss occurs, but body compensates for the change E.g., brain: neural loss but robust individual cell growth (new dendrites, new connections) may help preserve thinking and memoryPhysical Aging: not only loss Stability Resiliency Capacity for growth,